Joe Costello (Dublin Central, Labour)
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I presume I am not the only Deputy who thinks people in his constituency are experiencing considerable delays in the processing of medical card applications and renewal applications. I have not seen anything like it in my life as a public representative. The delays are horrendous. Sick, old and disabled people are suffering because the Minister for Health and Children and the HSE decided to impose a system of processing medical card applications on top of a system designed to process the primary care reimbursement service, PCRS. The Minister should have learned from what she did with the HSE, imposing that layer of bureaucracy onto the health board system which, in itself, has been a disaster. She has now combined with the HSE to place this tier of centralisation of medical card applications and renewals on top of another system designed for an entirely different purpose.

There have been long delays, files have gone missing and there is chaos in the system. In the last analysis, the most vulnerable people suffer because they are the ones looking for medical cards and renewals; they are those left waiting and under stress, strain and anxiety because of the mismanagement and insensitivity in the way the HSE and the Minister for Health and Children have dealt with this matter.

There is a great lack of information for applicants. The actual service being provided in the PCRS is amazingly secretive. It is almost like Fort Knox. A person cannot simply turn up. The place is guarded by dogs and security personnel and ordinary members of the public cannot go near it. I understand the centre is in the Minister of State's constituency but people must deal with it as if it was a limbo situation. It is non-personal and there is no opportunity for a person to speak with personnel to ask how his or her application is processing. It has gone into the secretive centralised centre to which nobody has access - not a good approach in terms of transparency and dealing with the public. I understand the PCRS was not consulted about this plan but that it was simply announced and then imposed on that body which did not have the services, personnel or resources to cater for this. Belatedly, the Minister has begun to provide some resources.

As early as 19 January, the Minister told the Oireachtas she fully supported the centralisation of the medical card application process and that centralisation would make the whole system more efficient. She said at the time it would take only 15 working days to process an application. That is cloud cuckoo land. The situation has not improved. I will be interested to hear whatever figures the Minister of State will trot out but six months later there is no sign of any improvements or improved efficiency in the system. It still takes months to process applications and renewals and many of the files go missing in transit.

I must agree with the statement of the Ombudsman, Ms Emily O'Reilly, who said the HSE is living in another world. The Minister is also living in another world; it certainly is not one related to reality. The Ombudsman was speaking about her own dealings with the HSE which she described as being from Alice in Wonderful. We all experience this.

I do not know whether the Minister of State has a hot line to deal with medical card applications for his constituents but the system is not working satisfactorily. It may be that only my constituency is experiencing this dire service. However from comments I have heard from colleagues it seems this is a universal problem throughout the country. I noted many cases that I have forwarded to the HSE and to the Minister. The Minister acknowledges them and says she must send them to the HSE. The HSE come back to me after a long time with replies. It is very unsatisfactory and everything is in process. It is in a state of chassis and it does not reach a conclusion.

I would like to know whether there will be any improvements in the existing system and why there are so many people in my constituency who find this dire situation in regard to their applications for new medical cards or renewals.

Pat Carey (Dublin North West, Fianna Fail)
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I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. The determination of eligibility of applicants to medical cards is a matter for the Health Service Executive as provided for under the provisions of the Health Act, 1970. Medical cards are provided to persons who, in the opinion of the HSE, are unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants. Prior to January 2009, local health offices provided the public with advice and assistance in regard to applying for medical cards and processed medical card applications in more than 100 offices around the country.

As part of the HSE's ongoing programme to provide a more responsive and cost effective service, the HSE is centralising the processing aspect of medical card applications to its facility at the primary care reimbursement service in Dublin, as Deputy Costello noted. Under the centralisation plan, the HSE's local offices will continue to provide the public with assistance and information locally in regard to medical card eligibility and making an application, and the current status of their application or review.

From the customer's perspective, this means that at all times he or she will be able to seek advice from his or her local health office. Local health offices have access to the national system to help clients with inquiries about their application or review and can also deal with queries of a general nature regarding the medical card scheme.

On 11 June, the HSE launched a new website - www.medicalcard.ie - where individuals can make a medical card application online, track the status of their application or review and access a simple eligibility checker to check the current eligibility status of a medical card. There is also a new on-line feedback and enquiry facility for the public to communicate directly with the PCRS. Since the processing of medical cards for persons aged 70 and over was centralised in January 2009, the HSE has processed 2,801 renewal applications from clients aged 70 or over in Dublin North Central, the local health office area which covers the constituency area of Dublin Central, of which 2,673, or 95%, resulted in a new medical card being issued. A total of 106 or 3.8% of applications were submitted without the necessary supporting documentation and the HSE is working with those applicants so that their applications may be completed. A very small proportion - less than 0.32% - of applicants were unsuccessful following review.

In regard to persons aged 70 years and over, the HSE recently introduced a new simplified declaration process for reviewing those cards so that the vast majority of persons aged 70 years and over do not have to undergo the more onerous review application form. The new declaration comprises a single page form that can be completed with a single entry, signed and dated, in the event that the circumstances of the medical card holder and his or her dependants have not materially changed since their last review. In respect of clients under 70 years of age in Dublin North Central, the HSE has processed 8,341 reviews, of which 6,946, or 83%, resulted in a new medical card being issued. Some 1,125 or 13.5% of applicants are in communication with the HSE as their applications were submitted without all of the necessary documentation. In this case, less than 2.5%,205 applications, were unsuccessful following assessment in line with the national medical card -general practitioner visit card guidelines.